Medicaid Work Requirements Risk Coverage Loss

5.2 million people may lose Medicaid. Not from cuts. From paperwork.

This is the detail that gets lost in the political debate, and it is the detail that matters most for health system leaders and FQHC executives managing Medicaid-dependent patient populations.

The Senate reconciliation bill advancing in 2026 includes mandatory work requirements for Medicaid recipients. The political argument is straightforward: able-bodied adults should work in exchange for benefits. The data tells a more complicated story.

The Congressional Budget Office projects roughly 5.2 million people would lose Medicaid coverage under these requirements. The CBO's own analysis is clear that the overwhelming majority of those losses would not come from people who stopped working. They would come from documentation failures — people working but unable to prove it on the required timeline, people in jobs without consistent pay stubs, peo…